Canadian Journal of Anaesthesia

, Volume 48, Issue 1, pp 20–27

Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty

  • Christian-S. Degoute
  • Marie-J. Ray
  • Monique Manchon
  • Christian Dubreuil
  • Vincent Banssillon
General Anesthesia

Abstract

Purpose: To determine whether remifentanil, combined with propofol, could induce controlled hypotension, reduce middle ear blood flow (MEBF) measured by laser-Doppler flowmetry, provide a “dry” operative field, and could be compared with nitroprusside or esmolol combined with alfentanil and propofol.

Methods: Thirty patients undergoing tympanoplasty and anesthetized with 2.5 mg·kg−1 propofoliv followed by a constant infusion of 120µg·kg−1·min−1, were randomly assigned in three groups to receive either 1µg·kg−1 remifentaniliv followed by a continuous infusion of 0.25 to 0.50µg·kg−1, or nitroprussideiv, or esmololiv combined for the latter two groups with alfentaniliv.

Results: Controlled hypotension was achieved at the target pressure of 80 mmHg within 107±16, 69±4.4, 53.3±4.4 sec for remifentanil, nitroprusside and esmolol respectively. MEBF decreased by 24±0.3, 22±3.3, 37±3% and preceded the decrease in SABP, within 30±6.1, 11.2±3.1, 15±2.8 sec for remifentanil, nitroprusside and esmolol respectively. Remifentanil, and nitroprusside decreased MEBF autoregulation less than esmolol (0.36±0.1, 0.19±0.2, −0.5±0.2). Controlled hypotension was sustained in all three groups throughout surgery, and the surgical field rating decreased in a range of 80% in all three groups. Nitroprusside decreased pH and increased PaCO2. There were no postoperative complications in any of the groups.

Conclusions: Remifentanil combined with propofol enabled controlled hypotension, reduced middle ear blood flow and provided good surgical conditions for tympanoplasty with no need for additional use of a potent hypotensive agent.

Résumé

Objectif: Déterminer si le rémifentanil, associé au propofol, peut induire une hypotension contrôlée, réduire le débit sanguin de l’oreille moyenne (DSOM) mesuré par laser-Doppler, assurer un champ opératoire exsangue et être comparé au nitroprussiate et à l’esmolol associés à l’alfentanil et au propofol.

Méthode: Trente patients subissant une tympanoplastie, et anesthésiés par 2,5 mg·kg−1 de propofoliv suivis d’une perfusion de 120µg·kg−1·min−1, ont été répartis après randomisation en 3 groupes recevant soit 1µg·kg−1 de rémifentaniliv suivis d’une perfusion de 0,25 à 0,50µg·kg−1·min−1, soit du nitroprussiate, soit de l’esmololiv, associé pour les 2 derniers à de l’alfentanil.

Résultats: Tout d’abord, l’hypotension contrôlée a été obtenue au niveau souhaité de 80 mmHg en 107±16; 69±4,4; 53,3±4,4 sec pour le rémifentanil, le nitroprussiate et l’esmolol. Le DSOM a diminué de 24±0,3; 22±3,3; 37±3% et a précédé la chute de pression de 30±6,1; 11,2±3,1; 15±2,8 sec pour le rémifentanil, le nitroprussiate et l’esmolol. Le rémifentanil et le nitroprussiate ont moins réduit l’autorégulation que l’esmolol (0,36±0,1; 0,19±0,2; −0,5±0,2). Ensuite, l’hypotension contrôlée a été maintenue dans les 3 groupes tout au long de l’opération, et le saignement opératoire a été diminué de 80% dans les 3 groupes. Le nitroprussiate a diminué le pH et augmenté la PaCO2. Il n’y a eu aucune complication postopératoire dans chacun des groupes.

Conclusion: Le rémifentanil associé au propofol a permis de réaliser une hypotension contrôlée, de réduire le débit sanguin de l’oreille moyenne et d’assurer de bonnes conditions opératoires pour la tympanoplastie sans recours à un agent hypotenseur puissant.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Christian-S. Degoute
    • 1
  • Marie-J. Ray
    • 1
  • Monique Manchon
    • 2
  • Christian Dubreuil
    • 3
  • Vincent Banssillon
    • 1
  1. 1.From the Departments of AnesthesiologyCentre Hospitalo-Universitaire Lyon-SudFrance
  2. 2.Service of BiochemistryCentre Hospitalo-Universitaire Lyon-SudFrance
  3. 3.Department of ENT SurgeryCentre Hospitalo-Universitaire Lyon-SudFrance
  4. 4.Service d’Anesthésie-réanimationCentre Hospitalo-Universitaire Lyon-SudPierre-Bénite-CedexFrance

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